This form should be completed and submitted as soon as possible after the Accident / Injury / Accident.

On submission of this form, a claim will be provided to the injured person/s. For details of the coverage provided under the National Insurance Program, please refer to the Club Administration section of the Probus South Pacific website which can be accessed with your Probus Membership Card number as the login and password.

If you have any questions about this form, please contact the PSPL by email or phone (1300 630 488)